Access to a ‘continuum of care’ needed, before, during and after pregnancy and childbirth.
Today the World Health Organization (WHO) and UNFPA launched five critical targets to help countries get back on track in reducing preventable maternal deaths, and for tracking progress against the Sustainable Development Goals.
Globally, maternal mortality declined by more than a third from 2000 to 2017. Yet, tragically, an estimated 810 women continue to die each day due to complications of pregnancy and childbirth – mostly from preventable or treatable causes, such as infectious diseases and complications during or after pregnancy and childbirth.
For every woman who dies of pregnancy-related causes, many more suffer from morbidity, disabilities and ill-health that can last a lifetime. Worryingly, the COVID-19 pandemic has caused major disruptions to health services that have exacerbated such risks, particularly for the most vulnerable families.
“All women and babies need access to affordable and high quality care before, during and after pregnancy and childbirth,” said Dr Anshu Banerjee, Director for Maternal, Child and Adolescent Health and Ageing at WHO. “These new targets will be critical for delivering an effective continuum of care for maternal and newborn health, from access to sexual and reproductive health services to those vital checks in pregnancy, as well as the often neglected postnatal period.”
The world is currently off-track to meeting Sustainable Development Goal (SDG) 3.1 for reducing maternal deaths – meaning urgent action is needed to improve the health and survival of women and babies.
Five clearly defined global and national targets for 2025
The Ending Preventable Maternal Mortality (EPMM) initiative, which includes a broad coalition of partners working in maternal and newborn health, has established new coverage targets and milestones that need to be achieved by 2025 if the SDGs are to be met. Globally, these are for:
- 90% pregnant women to attend four or more antenatal care visits (towards increasing to eight visits by 2030);
- 90% births to be attended by skilled health personnel;
- 80% women who have just given birth to access postnatal care within two days of delivery;
- 60% of the population to have access to emergency obstetric care within two hours of travel time;
- 65% of women to be able to make informed and empowered decisions regarding sexual relations, contraceptive use, and their reproductive health.
Specific targets are also outlined to help countries achieve greater equity and coverage at the national and subnational levels.
Tailoring responses to the countries where women face the greatest risks
Most maternal deaths are concentrated in a relatively small number of countries, with two-thirds occurring in Sub-Saharan Africa. Countries with the highest burden need intensified support to ensure women and children receive the healthcare they need at this critical stage of life.
All stakeholders will need to take action and increase commitment and investment, with approaches tailored to local context and challenges. Partners involved in developing the targets urge governments and other involved to:
- Adopt the coverage targets in their national policies and strategies;
- Convene national and sub-national action groups to track and guide progress toward goals;
- Enhance sufficient resources to address disparities in maternal health;
- Support donor cooperation for maternal health along the continuum of care;
- Strengthen intersectoral policy dialogues encompassing female education and security, and a human rights-based approach to sexual, reproductive, maternal and newborn health.
The targets were developed through two rounds of consultations between September 2020 and February 2021 with inputs from 40 countries.
Achieving high quality care for women and newborns
While these targets focus primarily on equitable access to healthcare, this is only one part of the equation. It will also be critical to ensure this healthcare is of a high-enough quality to meet the needs of families, and ensure they are treated with dignity and respect.
WHO provides support for delivering essential packages of high-quality maternal and newborn services, through technical guidance and support to country programmes. In particular, it has developed guidelines on antenatal and intrapartum care and a policy brief on nurturing care for newborns, with guidelines on postnatal care to be published in the coming months.
These publications can be used to establish a model in which health systems support families physically, psychologically, socially and emotionally throughout pregnancy and childbirth.
SDG 3.1 sets out that by 2030, the global maternal mortality ratio (MMR) should be reduced to less than 70 per 100,000 live births, and no country should have an MMR more than 140 per 100,000 live births. The latest estimates are 211 per 100,000 live births – but increasing to 415 on average in the poorest countries.